title: Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes.
abstract: BACKGROUND
  In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay fever patients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful to the patient.
  
  
  OBJECTIVE
  Investigate if the depot-steroid treatment of allergic rhinitis instead of immunotherapy increases risk of steroid-related diseases.
  
  
  METHODS
  A retrospective study based on Danish National Registries 1995-2011 covering diagnoses, medications, as well as clinical outcomes. The main analysis was time dependent poisson regression models with results presented as rate ratios (RR), and incidence per 1000 patient years. Steroid use was defined as minimum one injection during April-July for at least three consecutive years. Treatment with specific immunotherapy against grass, birch or both was used as non-steroid control group. Relative risk of adverse outcomes such as osteoporosis, infections, diabetes and/or tendon rupture was investigated.
  
  
  RESULTS
  We identified 47,382 individuals with rhinitis; 55.8% treated with steroids, 37.6% with immunotherapy, and 6.7% with both. No significant differences in infections or tendon rupture were observed. For steroid treatment RR of diabetes was 1.5 (95% CI: 1.3-1.8; P < 0.001), incidence 3.9 (95% CI: 3.5-4.3), and RR of osteoporosis was 1.2 (95% CI: 1.0-1.5; P = 0.023), incidence 2.8 (95% CI: 2.5-3.1). Risk of diabetes culminated within the first two years of treatment start.
  
  
  CONCLUSIONS
  Compared to immunotherapy regular use of depot-steroid injections to treat allergic rhinitis is associated with increased risk of being diagnosed with diabetes and osteoporosis.
  
  
  CONCLUSIONS
  Treating seasonal allergic rhinitis with depot-steroid injections should be abandoned and replaced with immunotherapy, as annual depot-steroid treatment is associated with increased risk of diabetes and osteoporosis.
authors.affiliation: Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark. Electronic address: kristian@aasbjerg.dk.
authors.forename: Kristian
authors.initials: K
authors.lastname: Aasbjerg
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Allan
authors.initials: A
authors.lastname: Vaag
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D003692:Delayed-Action Preparations; D003888:Desensitization, Immunologic / Q000379:methods; D003920:Diabetes Mellitus / Q000139:chemically induced*; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced*; D012189:Retrospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D003692:Delayed-Action Preparations; D006633:Histamine Antagonists; D013256:Steroids
keywords: AIT; AR; ARIA; ATC; Allergy; Anatomical Therapeutic Chemical Classification; COPD; Cancer; Diabetes; ICD; Immunotherapy; International Statistical Classification of Diseases and Related Health Problems ICD; RR; Rhinitis; SCIT; SIT; SLIT; Steroid; allergen immunotherapy tablets; allergic rhinitis; allergic rhinitis and its impact on asthma; chronic obstructive pulmonary disease; rate ratios; specific immunotherapy; subcutaneous immunotherapy; sublingual immunotherapy